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Workplace and Patient Safety

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Hospital Workplace and Patient safety: The first interventions for positive outcome

Outline of the Article

I. Backgound

II. Objective

III. Errors due to fatigue of nursing personnel

IV. Healthcare Associated Infections

V. Personal Protective equipments

VI. Hand Hygiene

VII. Transitions of care and Patient Handoffs

VIII. Conclusion

IX. References

Hospital Workplace and Patient safety: The first interventions for positive outcome Background

Safety of any workplace is very important in optimizing productivity and preventing the incidences of accidents and casualties. Hospitals are one of the significant areas where safety is of prime concern not only for the employees and care givers, but also for the patients who are admitted for receiving health care. A compromise on safety jeopardizes the goodwill of the hospital and delays health outcome in patients and prolongs their stay in the hospital. Apart from that if safe methods and interventions are not followed it ca impact the nursing personnel, other health care providers and administrative staff, that will lead to the economical and financial burden of the hospital. Hence ensuring safety in hospitals is of prime importance (ISMP,2010). The present article will discuss some of the avenues which can jeopardize the safety of the patients and the care providers and possible interventions that can improve the safety aspects of a hospital.

Objective

The article describes the issues related to the safety of employees and patients in a hospital setting and the factors that influences such safety parameters in the workplace. Broadly the article reviews safety issues related to fatigue levels of nursing personnel, overall approach in infection control both at systemic level and personal level, the spread of infections and its control and care approaches that needs to be taken while a transition of patient from one medical unit to another takes place or the transition of duty from one staff nurse to another

Errors due to fatigue of nursing personnel

Various types of intervention errors occur through nursing personnel due to their job stress, mental and physical fatigue. As nurses have to manage a wide array of patient population and that too in different settings, they become stressed by workload and more so if the shift periods are prolonged. Workplace fatigue has been attributed to one of the most important internal factors that lead to medication errors (Maust Martin, 2015). Medication errors may include administration of the wrong medication, or administration of a medication in incorrect doses or selecting different routes of administration that is not recommended, and also failure to check the expiry dates and difficulty in titrating stock solutions. A study done on 12 hour shift period of nurses indicated that older peers committed more medication errors than their younger peers. Fatigue sets in either from the complexity of health care practise or from the increased work load of health care settings (Marx, 2014).

Hence, proper and adequate deployment of work force is highly critical in health care settings. It is also the duty of the staff nurse to escalate her mental conditions to the RN, so that she can be deployed in lesser critical units to avoid chances of medication errors (Koppel et al., 2008). Fatigue can also be prevented by employing relaxation techniques in care settings. There should also be proper screening techniques to understand the level of fatigue of particular nursing personnel on a particular day and if needed she should be deployed in less critical units to avoid chances of errors. This is because critical care patents often lack suitable coping strategies to combat the errors that jeopardize their safety.

Healthcare Associated Infections

Healthcare Associated Infections not only impacts the patients who are admitted but also the care providers who are deployed for providing care. The major healthcare associated infections are nosocomial infections and transmission diseases like hepatitis A and B. Nosocomial infections are hospital acquired infections and are mainly caused by gram negative organisms and methicilin resistant staphylococcus. These are opportunistic pathogens and whenever a patient is febrile or having a decreased immune function, these pathogens cause super infections that leads to increased morbidity and mortality in patients. These pathogens may also infect health care providers who have a compromised nutritional and immunological status and such individuals are readily attacked by these pathogens. The major cause of their prevalence is under dosing of antibiotic regimes, improper asepsis procedures in healthcare settings and development of resistance against antibiotics by such pathogens (Wolfe et al.,2011).

Care should be taken to eradicate these pathogens through appropriate antibiotic in the affected patients but also these pathogens must be controlled in the hospital environment through proper fumigation. Fumigation must be carried out routinely in intensive care units and the operation theatres where the chances of infection are very high (Robins & Feng, 2015).

Personal Protective equipments

Personal protective equipments play an important role in ensuring the safety of the patients and care providers. Such instruments include gloves, goggles, aprons and face masks. However such protective devices must be properly sterilized before they are put to use. Personal protective equipments must be intended for personal use both for the patients and the care providers. They should not add to the disease burden of health care settings and must be biodegradable to protect the environmental toxicity in care settings. Apart from the protective equipments any equipments or devices intended for personal use should be discarded and disposed properly. Such equipments include the injection needles, the IV set, swabs and bandages (Palmer, 2014).

Hand Hygiene

Since the skin harbours a wide spectrum of pathogens, it is important that care givers should properly maintain hand hygiene. They should wash their hands following proper hand washing techniques and must intervene one patient to another after applying sterilization solutions on their hands and chiefly the portions of the hand that can have direct contact to patients (Infection Nursing Society, 2000).

Transitions of care and Patient Handoffs

One area where the safety of an individual is compromised is during the transition from one health care unit to another health care unit. Medication errors like missed doses or repetition of doses or procedures are quite common due to inadequacy of documentation during such transition period. Further when there is a change in the shift duty of a nurse, communication gap also leads to mistakes and errors by nursing personnel that compromises the safety of a patient. Hence care should be taken through the electronic health record systems to monitor the medications and approach of care either during transition of care from one medical unit to another or transition of care between different shifts. Nurses should reflect upon practice to ensure quality and safety of care is maintained (Canadian Disclosure Guidelines, 2014).

Conclusion

There is a saying that asepsis is better than antisepsis. Hence, if the care providers and hospital administration provides adequate importance to safety issues in care settings it will not only benefit the patients but the employees of that healthcare organization too. Both issues will help to ensure and improve the goodwill of such healthcare institution. In fact the SOP and GCP are implemented in various care settings to comply with quality and safety standards.

References

"Canadian Disclosure Guidelines BEING OPEN WITH PATIENTS AND FAMILIES" (PDF). Patient Safety Institute. p. 16. Retrieved 30 October 2014

David Marx. "Patient Safety and the "Just Culture:" A Primer For Health Care Executives" (PDF). University of California Los Angeles. Retrieved30 October 2014.

INSTITUTE FOR SAFE MEDICATION PRACTICES.(2010). ISMP Medication Safety

Alert! Nurse Advise-ERR [Newsletter]. http://www.ismp.org/Newsletters/

nursing/default.asp. Accessed February 1, 2010.

Infusion Nursing Society (2000). "Infusion nursing standards of practice". J Intraven

Nurs 23 (6 Suppl): S1–85

KOPPEL R, WETTERNECK T, TELLES J, KARSH B.(2008). Workarounds to

barcode medication administration systems: their occurrences, causes, and

threats to patient safety. J Am Med Inform Assoc;15(4):408-423

Maust Martin, D. (2015). Nurse Fatigue and Shift Length: A Pilot Study. Nursing Economic$, 33(2), 81-87.

Palmer, M. (2014).YOUR ROLE IN INFECTION PREVENTION. ASBN Update, 18(4), 10

Robins, H., & Feng, D. (2015). Handoffs in the Postoperative Anesthesia Care Unit: Use of a Checklist for Transfer of Care. AANA Journal, 83(4), 264-268.

Wolf, Zane Robinson; Hughes, Ronda G.(2011) Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Chapter 35: Agency for Healthcare Research and Quality.

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